Dr. Smith-Bindman is an Assistant Professor in Radiology, and recently completed a two year fellowship in epidemiology, biostatistics, and research design sponsored jointly by the Departments of Epidemiology and Biostatistics and the General Internal Medicine Section, University of California, San Francisco. Her broad research interest is in performing outcome assessment of diagnostic imaging tests in areas targeted to women's health. Specifically her research interest is in evaluating the outcomes of performing mammographic screening in elderly women. A more thorough understanding of the relationship between screening mammography, breast cancer detection and treatment, and breast cancer mortality is critical to the planning of public policy regarding who should undergo mammographic screening. The proposed study involves the design and implementation of a data analysis of California Health Care Financing Administration Medicare billing claims that have been linked with tumor registry data from the California Cancer Registry on breast cancer stage and treatment. The data will be analyzed at the California Medical Review Incorporated, a Medicare quality improvement organization. Similar data has been successfully analyzed by this investigator previously. The specific aims will focus on the outcome of performing screening mammography in women older than age 65 years. The proposal will evaluate the following: 1) differences in breast cancer mortality, 2) differences in breast cancer treatment rates including mastectomy, lumpectomy and radiation and 3) difference in breast cancer tumor attributes including size and stage between women who were previously screened with mammography and women who were not. She will also evaluate if women with co-morbidities have different outcomes from undergoing screening as women without co-morbidities. For the training component of the award, she will take additional course work in biostatistical methods to develop expertise in adjustment for confounding, and she will meet regularly with her sponsors. Dr. Smith-Bindman has assembled a multidisciplinary team of nationally recognized clinical researchers. They are enthusiastic about her research plan and are dedicated to assisting her in developing outstanding research skills and successfully completing the planned research. The Career Development Award will provide five years of supervised experience to enable Dr. Smith-Bindman to become an independent investigator in the area of mammographic screening in elderly women.